Abstract
This investigation was carried out in ten patients undergoing elective Caesarean section and the results were compared with those of a control group of ten nonpregnant females of the same age group. The study investigated the onset of vecuronium neuromuscular block and the conditions of tracheal intubation when ketamine (1.5 mg · kg−1)-vecuronium 100 μg · kg−1) sequence was used for rapid-sequence induction of anaesthesia. The ulnar nerve was stimulated supra-maximally at the wrist with train-of-four stimuli every 20 sec, and the electromyographic response of the adductor pollicis muscle was displayed. The onset of 50% neuromuscular block as monitored by electro-myography was shorter in the Caesarean group (80 ± 30 sec) than in the control group (144 ± 43 sec). The conditions of intubation at 50% block were adequate in both groups. Also, the onset of 90% block was shorter in the Caesarean group. The time of recovery to T1/control ratio of 25% was longer in the Caesarean group (46 ± 10 min) than in the control patients (28 ± 10 min). The results show that administration of vecuronium according to body weight results in a more rapid onset and delayed recovery of neuromuscular block in pregnant women undergoing Caesarean section than in the nonpregnant control patients.
Résumé
Cette étude fut conduite chez dix patientes devant subir une césarienne élective et les résultats furent comparés à un groupe contrôle de dix patientes non gravides ayant le même âge. Cette étude investigue l’installation du bloc neuromusculaire après vécuronium et les conditions d’intubation trachéale à la kétamine (1,5 mg · kg−1)-vécuronium (100 μg · kg−1) qui ont été utilisés pour une induction rapide de l’anesthésie. Le nerf cubital fut stimulé de façon supramaximale au niveau du poignet avec l’ondée-de-quatre (train-of-four) chaque 20 sec, et la réponse électromyographique de l’adducteur du pouce enregistrée. L’installation de 50% du bloc neuromusculaire, tel que démontré par électromyographie, fut plus courte dans le groupe césarienne (80 ± 30 sec) que le groupe contrôle (144 ± 43 sec). Les conditions d’intubation à 50% de bloc furent adéquates dans les deux groupes. Aussi, l’installation d’un bloc à 90% était plus court dans le groupe césarienne. Le temps de récupération pour un rapport T1/contrôle de 25% était plus long pour le groupe césarienne (46 ± 10 min) que le groupe contrôle (28 ± 10 min). Les résultats démontrent que l’administration de vécuronium selon le poids amène une installation du bloc neuromusculaire plus rapide et une récupération plus tardive chez les patients devant subir une césarienne que celles non gravides du groupe contrôle.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Hawkins JL, Johnson TD, Kubicek MA, Skjonsby BS, Morrow DH, Joyce IIITH. Vecuronium for rapid-sequence intubation for cesarean section. Anesth Analg 1990; 71: 185–90.
Baraka A, Louis F, Delleh R. Maternal awareness and neonatal outcome after ketamine induction of anaesthesia for Caesarean section. Can J Anaesth 1990; 37: 641–4.
Lees MM, Taylor SH, Scott DB, Kerr MG. A study of cardiac output at rest throughout pregnancy. J Obst Gyn Br Commonwealth 1967; 74: 319–28.
Howard BK, Goodson SH, Mengen WF. Supine hypotensive syndrome in late pregnancy. Obs Gyn 1953; 1: 371–7.
Ginsburg J, Duncan S. Peripheral blood flow in normal pregnancy. Cardiovascular Research 1967; 1: 132–7.
Harrison GA, Junius F. The effect of circulation time on the neuromuscular action of suxamethonium. Anaesth Intensive Care 1972; 1: 33–40.
Goat VA, Yeung ML, Bladeney C et al. The effect of blood flow upon the activity of gallamine triethiodide. Br J Anaesth 1976; 48: 69–73.
Ganrot PO. Variation of the concentrations of some plasma proteins in normal adults, in pregnant women and in newborns. Scand J Clin Lab Invest 1972; 29: 83–8.
Demetriou M, Depoix JP, Diakite B, Fromentin M, Duvaldestin P. Placental transfer of Org NC45 in women under-going caesarean section. Br J Anaesth 1982; 54: 643–5.
Weinstein JA, Matteo RS, Ornstein E, Schwartz AE, Goldstoff M, Thal G. Pharmacodynamics of vecuronium and atracurium in the obese surgical patient. Anesth Analg 1988; 67: 1149–53.
Baraka A, Noueihid R, Sinno H, Wakid N, Agoston S. Succinylcholine vecuronium (ORG NC45) sequence for cesarean section. Anesth Analg 1983; 62: 909–13.
Camp CE, Tessem J, Adenwala J, Joyce IIITH. Vecuronium and prolonged neuromuscular blockade in postpartum patients. Anesthesiology 1987; 67: 1006–8.
Khuenl-Brady KS, Koller J, Mair P, Puhringer F, Mitterschiffthaler G. Comparison of vecuronium and atracurium in postpartum and nonpregnant patients. Anesth Analg 1991; 72: 110–3.
Chauvin M, Lebrault C, Duvaldestin P. The neuromuscular blocking effect of vecuronium on the human diaphragm. Anesth Analg 1987; 66: 117–22.
Schultetus RR, Paulus DA, Spohr GL. Haemodynamic effects of ketamine and thiopentone during anaesthetic induction for Caesarean section. Can Anaesth Soc J 1985; 35: 592–6.
L’Hommedieu CS, Arens JJ. The use of ketamine for the emergency intubation of patients with status asthmaticus. Ann Emerg Med 1987; 16: 568–71.
Hirshman CA, Downes H, Farbood A, Bergman NA. Ketamine block of bronchospasm in experimental canine asthma. Br J Anaesth 1979; 51: 713–8.
Schwarz S, Ilias W, Lackner F, Mayrhofer O, Foldes FF. Rapid tracheal intubation with vecuronium: the priming principle. Anesthesiology 1985; 62: 388–91.
Toboada JA, Rupp SM, Miller RD. Refining the priming principle for vecuronium during rapid-sequence induction of anesthesia. Anesthesiology 1986; 64: 243–74.
Ginsberg B, Glass PS, Quill T, Shafron D, Ossey KD. Onset and duration of neuromuscular blockade following high-dose vecuronium-administration. Anesthesiology 1989; 71: 201–5.
Sosis M. A caution on vecuronium priming. Anesthesiololgy 1985: 63: 460.
Cicala R, Westbrook L. An alternative method of paralysis for rapid-sequence induction. Anesthesiology 1988; 69: 983–6.
Baraka A. Rapid onset of suxamethonium block. Br J Anaesth 1991; 66: 733.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Baraka, A., Jabbour, S., Tabboush, Z. et al. Onset of vecuronium neuromuscular block is more rapid in patients undergoing Caesarean section. Can J Anaesth 39, 135–138 (1992). https://doi.org/10.1007/BF03008643
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03008643